How to avoid a heart attack

Intensive dietary education

In the investigation, the researchers randomly divided 101 people who had recently survived a heart attack into two different heart-healthy diet groups. Both groups received intensive dietary education – seven individual counseling sessions and at least six small group workshops led by registered dietitians over the course of two years.  It was comprehensive coaching in good food and good health, similar to the nutrition education taught at the renowned Pritikin Longevity Center in Miami.

Usual care

Another 101 patients, also recent heart attack victims, were given usual care – one short visit from a dietitian on the benefits of a low-fat, fiber-rich diet before being discharged from the hospital.

The first intensive education group (50 people) followed the American Heart Association Step II diet, which emphasized whole grains and fruits and vegetables with moderate lean animal protein, reported lead investigator Katherine Tuttle, MD.

The second group (51 people) was instructed in the Mediterranean-style diet, which also focused on whole grains, fruits, and vegetables but emphasized fish and other sources of omega-3 fatty acids in lieu of animal-based fat.

Both diets recommended limiting cholesterol consumption to less than 200mg a day and saturated fats to less than 7% of total calories.

How to avoid a heart attack

Six years after the study began, Dr. Tuttle and colleagues found that the two groups that received intensive education in heart-healthy diets were significantly more likely than people in the usual-care group to avoid deaths, heart attacks, unstable angina, and other cardiovascular-related events. (See graph.)

A total of eight events occurred in each of the dietary intervention groups, none of them deaths. In sharp contrast, 40 events occurred in the usual-care group, seven of which were deaths.

Overall, the intensive education groups slashed the risk of cardiovascular events by two-thirds compared to the usual-care group.

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ApoB - heart disease

A growing body of research is finding that apoB may be a better predictor of heart disease risk than long-standing federal guidelines for “good” HDL and “bad” LDL cholesterol. What is apoB? (Its official name is apolipoprotein B.)

What Is ApoB?

To understand apolipoprotein B, it’s important to first understand how cholesterol moves through the body.

Cholesterol, all by itself, cannot dissolve in the blood. It must be carried through the bloodstream by transporters called lipoproteins.

Lipoproteins = Lipids + Proteins

Lipoproteins got their name because they are made up of fats (lipids), such as cholesterol and triglycerides, and proteins.

ApoBs | Part of Artery-Clogging Lipoproteins

ApoBs are proteins found in lipoprotein particles that are artery-clogging.

The apoB-containing lipoprotein particles that are the most damaging to our arteries include not only LDL cholesterol but also remnants of chylomicrons and VLDL (very low density lipoproteins).  All three– LDL, VLDL, and chylomicrons – promote atherosclerosis.

What Is Atherosclerosis?

Atherosclerosis is a disease caused in large part by the build-up of excess cholesterol within the artery wall, which leads to cholesterol-rich deposits called plaque. When a plaque bursts or ruptures, blood clots form. They’re dangerous because they can block blood flow to vital organs like the heart and brain.

Atherosclerosis, therefore, is the underlying disease process that leads to nearly all heart attacks and most strokes.

ApoB and Atherosclerosis

Now, let’s get back to apoB.

Since each apoB-containing lipoprotein particle has one apoB molecule, “measuring apoB levels in fasting blood gives us a good approximation of the total number of atherogenic lipoproteins in the blood. The greater the number, the greater the risk of more cholesterol ending up in the artery wall and, in the long term, the greater the risk of a heart attack,” explains Dr. Jay Kenney, Nutrition Research Director at the Pritikin Longevity Center.

In fact, research 1,2 has shown that apoB may be a better predictor of cardiovascular disease than LDL cholesterol.

Two Types of ApoB

Keep in mind, too, that there are two types of apoB. Both are bad news for our arteries. One type is made in the intestines. It’s called apoB-48, and its lipoprotein partner is chylomicrons. Another type is made in the liver. It’s called apoB-100. Its partners are primarily LDL and VLDL.

How To Lower ApoBs

“Consuming less dietary fat and cholesterol and many more fiber-rich, whole plant foods, which is essentially the Pritikin Eating Plan, will greatly reduce the amount of chylomicrons and their atherogenic, apoB-48-containing lipoproteins in the blood,” states Dr. Kenney.

“This same type of dietary pattern will also reduce the liver’s production of apoB-100- containing lipoproteins, which includes VLDLs, LDLs, and IDLs, or intermediate density lipoproteins.”

Fasting Blood Tests | What Shows Up, What Doesn’t

ApoB-100-containing lipoproteins remain in the blood far longer than chylomicrons and their remnants, which means it’s apoB-100s and their lipids LDL, IDL, and VLDL that show up in fasting blood tests, not chylomicrons.

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